Teachable moment for lifestyle and dietary changes after a myocardial infarction: identifying the window of opportunity

Abstract

Background and aims: While lifestyle changes, including dietary modifications, are crucial for reducing cardiovascular risk, adherence to these changes remains low. A 'teachable moment' (TM) can improve adherence, and a myocardial infarction (MI) can serve as a TM for initiating lifestyle and dietary changes. However, the timing and duration of receptiveness remain unclear. This study aimed to investigate whether an MI serves as a TM for lifestyle and dietary change intentions, to explore when this TM is most pronounced and to identify predictors of this TM. Methods: In this cross-sectional survey study, patients who experienced an MI reported their intentions to change lifestyle and diet, along with the validated CardiacTM scale. Patients were categorised based on the time since MI: within 2 weeks, 6 months, 1 year, and 3 years ago. Intentions to change lifestyle and diet were compared between groups. Logistic regression analyses were performed to examine the association between the CardiacTM factors, time elapsed post-MI and intentions to change lifestyle and diet. Results: 241 patients were included in the analyses. Event-related lifestyle change intentions differed significantly between the 6-month and 1-year post-MI groups (30.6 % vs. 55.4 %, p = 0.003), as well as between the 2-weeks and 6-month post-MI groups (54.3 % and 30.6%p = 0.010). The intention to change dietary behaviour and general lifestyle were comparable across groups. Multivariate logistic regression revealed that time post-MI (p = 0.018), changed self-concept (B = 0.748; p < 0.001) and cardiovascular disease (CVD) group identity (B = 0.550; p = 0.021) were significantly associated with event-related lifestyle change intentions. Affective impact (B = -0.496; p < 0.001), changed self-concept (B = 0.506; p < 0.001), perceived risk of non-communicable diseases (NCD) (B = -0.450; p = 0.003) and anticipated regret (B = 0.345; p = 0.008) were significantly associated with general lifestyle change intentions. Significant predictors of dietary change intentions were affective impact (B = 0.298; p = 0.025) and changed self-concept (B = 0.518; p < 0.001). Conclusions: A significant association was found between time post-MI and event-related lifestyle change intentions. Changed self-concept was the strongest predictor of TM for dietary, event-related and general lifestyle change intentions. These results suggest lifestyle interventions should be provided shortly after the event and personalised based on patients' perceptions of their MI to maximise effectiveness.